Fukihara Jun, Kondoh Yasuhiro, Brown Kevin K, Kimura Tomoki, Kataoka Kensuke, Matsuda Toshiaki, Yamano Yasuhiko, Suzuki Atsushi, Furukawa Taiki, Sumikawa Hiromitsu, Takahashi Osamu, Johkoh Takeshi, Tanaka Tomonori, Fukuoka Junya, Hashimoto Naozumi, Hasegawa Yoshinori
Dept of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan.
Eur Respir J. 2020 Apr 9;55(4). doi: 10.1183/13993003.02465-2018. Print 2020 Apr.
Recent studies have suggested that in patients with an idiopathic interstitial pneumonia (IIP), a probable usual interstitial pneumonia (UIP) pattern on chest computed tomography (CT) is sufficient to diagnose idiopathic pulmonary fibrosis (IPF) without histopathology.We retrospectively compared the prognosis and time to first acute exacerbation (AE) in IIP patients with a UIP and a probable UIP pattern on initial chest CT.One hundred and sixty IIP patients with a UIP pattern and 242 with a probable UIP pattern were identified. Probable UIP pattern was independently associated with longer survival time (adjusted hazard ratio 0.713, 95% CI 0.536-0.950; p=0.021) and time to first AE (adjusted hazard ratio 0.580, 95% CI 0.389-0.866; p=0.008). In subjects with a probable UIP pattern who underwent surgical lung biopsy, the probability of a histopathological UIP pattern was 83%. After multidisciplinary discussion and the inclusion of longitudinal behaviour, a diagnosis of IPF was made in 66% of cases. In IPF patients, survival time and time to first AE were not associated with CT pattern. Among subjects with a probable UIP pattern, compared to non-IPF patients, survival time and time to first AE were shorter in IPF patients.In conclusion, IIP patients with a probable UIP pattern on initial chest CT had a better prognosis and longer time to first AE than those with a UIP pattern. However, when baseline data and longitudinal behaviour provided a final diagnosis of IPF, CT pattern was not associated with these outcomes. This suggests diagnostic heterogeneity among patients with a probable UIP pattern.
近期研究表明，对于特发性间质性肺炎（IIP）患者，胸部计算机断层扫描（CT）显示可能为普通型间质性肺炎（UIP）模式足以在无组织病理学检查的情况下诊断特发性肺纤维化（IPF）。我们回顾性比较了初始胸部CT显示为UIP模式和可能为UIP模式的IIP患者的预后及首次急性加重（AE）时间。共纳入160例具有UIP模式的IIP患者和242例具有可能UIP模式的患者。可能的UIP模式与更长的生存时间（校正风险比0.713，95%可信区间0.536 - 0.950；p = 0.021）和首次AE时间（校正风险比0.580，95%可信区间0.389 - 0.866；p = 0.008）独立相关。在接受外科肺活检且具有可能UIP模式的患者中，则组织病理学UIP模式的概率为83%。经过多学科讨论并纳入纵向行为后，66%的病例被诊断为IPF。在IPF患者中，生存时间和首次AE时间与CT模式无关。在具有可能UIP模式的患者中，与非IPF患者相比，IPF患者的生存时间和首次AE时间更短。总之，初始胸部CT显示可能为UIP模式的IIP患者比具有UIP模式的患者预后更好，首次AE时间更长。然而，当基线数据和纵向行为最终诊断为IPF时，CT模式与这些结果无关。这表明具有可能UIP模式的患者存在诊断异质性。
